2024 Chinese Expert Consensus Guidelines on the Diagnosis and Treatment of Atrial Fibrillation in the Elderly, Endorsed by Geriatric Society of Chinese Medical Association (Cardiovascular Group) and Chinese Society of Geriatric Health Medicine (Cardiovascular Branch): Executive Summary

Figures

• 

  Fig. 1. Risk assessment of the elderly patients with AF. For the patients with a CHA 2 DS 2 -VASc score of low or intermediate risk at baseline, more frequent stroke risk evaluation, e.g., every 4 months, is proposed. AF, atrial fibrillation; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BP, blood pressure; CAD, coronary artery disease; CHA 2 DS 2 -VASc, congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65–74 years, sex category (female); CKD-EP, Chronic Kidney Disease Epidemiology Collaboration; EF, ejection fraction; HCM, hypertrophic cardiomyopathy; HF, heart failure; INR, international normalized ratio; LV, left ventricular; LVEF, left ventricular ejection fraction; NSAID, nonsteroidal anti-inflammatory drug; PAD, peripheral artery disease; SBP, systolic blood pressure; TIA, transient ischemic attack; TTR, time in therapeutic range; VKA, vitamin K antagonist.

• 

  Fig. 2. AF screening and monitoring for the elderly population. AF, atrial fibrillation; OSA, obstructive sleep apnea.

• 

  Fig. 3. An integrated care ABC pathway for the elderly population with atrial fibrillation. COPD, chronic obstructive pulmonary disease; F, female; m, male; INR, international normalized ratio; NOAC, non-vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; OSA, obstructive sleep apnea.

• 

  Fig. 4. Mobile health technology facilitated integrated care for the elderly patients with AF.

• 

  Fig. 5. Appropriate measures to reduce AF recurrence for the elderly patients receiving ablation. Clinical recurrence of AF: late recurrence or very late recurrence. AF, atrial fibrillation.

• 

  Fig. 6. Risk reductions in elderly patients with AF on OACs in special clinical setting (very elderly, multimorbidities, with CAD) and the increased risk of those without OACs or with underdosing of OACs. *TE and all-cause death reduced among the very elderly patients and with multimorbidities on OACs. The composite of all-cause death, TE, major bleeding, and acute coronary syndrome was reduced in the elderly patients with OACs. **For elderly patients with AF without OACs, the thromboembolic risk increased by 2.2-fold in those with CHA2DS2-VASc ≥1 in male, or ≥2 in female and by 2.5-fold in those with the underdoing of OACs. CAD, coronary artery disease; OACs, oral anticoagulants; TE, thromboembolism. (Cited from Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry. Eur Heart J Qual Care Clin Outcomes. 2023 J Arrhythm. 2022; Int J Stroke. 2022; Int J Stroke. 2021. 12 59 60 61 )

• 

  Fig. 7. Multimorbidity, polypharmacy, and high-risk thromboembolism and bleeding in the elderly population with AF. F, female; M, male. (Cited from Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry. J Am Heart Assoc. 2022; J Arrhythm. 2022. 8 59 )

• 

  Fig. 8. Periprocedural and perioperative risk assessment of the elderly population with AF. Intervention with minor bleeding: e.g., dental extractions (1–3 teeth), paradontal surgery, implant positioning, subgingival scalling/cleaning; cataract or glaucoma intervention endoscopy without biopsy or resection; superficial surgery (e.g., abscess incision, small dermatologic excisions, skin biopsy); pacemaker or ICD implantation (except complex procedures); electrophysiological study or catheter ablation (except complex procedures); routine elective coronary/peripheral artery intervention (except complex procedures); intramuscular injection (e.g., vaccination). Intervention with low-risk bleeding: e.g., complex dental procedures; endoscopy with simple biopsy; small orthopedic surgery (foot, hand, arthroscopy. Intervention with high-risk interventions: e.g., cardiac surgery; peripheral arterial revascularization surgery (e.g., aortic aneurysm repair, vascular bypass); complex invasive cardiological interventions, including lead extraction, (epicardial) VT ablation, chronic total occlusion, PCI, etc. Neurosurgery spinal or epidural anesthesia; lumbar diagnostic puncture; complex endoscopy…

• 

  Fig. 9. Continuation, discontinuation, bridging, or resumption of anticoagulation with warfarin, with regard to the time points in the perioperative period. INR, international normalized ratio; LMWH, low-molecular-weight heparin; OAC, oral anticoagulant.

• 

  Fig. 10. Continuation, discontinuation, bridging, or resumption of anticoagulation with NOACs, with regard to the time points in the perioperative period. NOAC, non-vitamin K antagonist oral anticoagulant.

• 

  Fig. 11. Management of chronic conditions in the elderly population with AF. ACE inhibitors, angiotensin-converting enzyme inhibitors; AF, atrial fibrillation; ARBs, angiotensin receptor blockers; NOACs, non-vitamin K oral antagonist anticoagulants.